Focusing “Down Low”: Bisexual Black Men, HIV Risk and Heterosexual Transmission: RESULTS

3 Nov

Prevalence of Bisexuality among Black Men
Studies clearly show that black MSM are more likely than MSM of other races and ethnicities to identify themselves as bisexual and to be bisexually active.101217 Most studies that recruited black bisexual men assessed bisexuality according to self-reported behavior rather than self-identifica-tion. Among black MSM in 18 studies, from 2% to 71% reported bisexual behavior, and from 11% to 40% self-identified as bisexual. These estimates varied based upon whether studies recruited only MSM or a general population of men. Time periods during which bisexual behavior was assessed varied from proximal estimates (e.g., past three months, six months or a year), to extended periods of time (e.g., five years, since 1977, lifetime). Others did not specify a time period. In two studies that provided estimates for both recent and historical bisexual behavior, the prevalence of bisexual behavior was higher when evaluated over a longer (>5 years) period of time than a shorter (within the past year) timeframe.

Two probability studies that identified bisexual activity according to self-reported behavior provide the best overall estimates of black men who have sex with both men and women (MSM/W). The National AIDS Behavioral Survey, a random-digit dialing telephone survey that oversampled black and Latino respondents, included 21 cities that accounted for the greatest AIDS prevalence in 1990. The study examined data from 560 black men (ages 18-49 years) of whom 19 (3%) reported sex with another man in the past five years. Approximately 57% of the subsample of black MSM (11 out of 19), or 2% of all black men in the study, reported bisexual activity during the five-year period. These estimates of MSM among the general black male population are comparable to other population-based estimates of MSM in the United States and Britain. In the second study, a multisite cross-sectional study of young MSM (ages 15-29 years) recruited by time-space sampling, 1,109 young black MSM were included. The authors found that 44% of black respondents reported having had >3 female sex partners in their lifetime; 20% had >1 current female sex partners, 14% reported having a main female sex partner, and 11% reported having had casual or commercial female sex partners. finasteride 5 mg

Table 1. Bisexual Activity among HIV-Positive Men of Various Sexual Identities

Bisexually Active MenSexual Identity
Heterosexual (%)Homosexual (%)

Bisexual (%)

Other* (%)

Black (n=530)1222



Hispanic (n=258)1028


White (n=326)931



Source: Montgomery et al., 2003; *Other: Sexual identity was’“other,” “refused to answer”or “not sure/don’t know”; t Men whose
reported bisexual identity matched bisexual behavior. Percentages do not add to 100 due to rounding.

Agreement between Heterosexual Identity and Behavior
In five studies, substantial proportions of hetero-sexually identified black men reported having sex with men.121719’25’34 A study of heterosexually identified black men in Los Angeles reported that approximately 33% of HIV-positive men and 16% of HlV-nega-tive men admitted to engaging in anal intercourse with men.19 Eight percent of black MSM recruited for an intervention study in Chicago identified as straight.34 Likewise, approximately 16% of homosex¬ually active black men recruited for two separate mul-tisite studies identified themselves as straight. However, identifying oneself as heterosexual and having sex with men is not unique to black men. Between 18% and 34% of heterosexual Latino men and between 18% and 46.5% of heterosexual white men reported anal or oral sex with a man in the past three months or during their lifetime in three of the studies. One study reported that the level of agreement between heterosexual identity and behavior was highest among Asian men (78.4%) and lowest among white men (34.7%). In comparison, the level of agreement for black men was 43%. dutasteride hair loss

MSM who identify themselves as heterosexual are not the only MSM who report having both male and female sex partners. In a recent study of 5,000 HIV-positive MSM, 22% of gay-identified black MSM and 61% of bisexual-identified black MSM reported having had sex with a woman in the past five years, compared with 12% of heterosexual-identified black MSM (Table l). In fact, among all races and ethnicities of HIV-positive MSM in the study, proportionally more gay or bisexually identified MSM had sex with women than straight-identified MSM. These data contradict the commonly held belief that heterosexually active women are primarily at risk for HIV (treating HIV infection) by MSM who identify as heterosexual.